Provider Demographics
NPI:1619390861
Name:MENDORES PC
Entity type:Organization
Organization Name:MENDORES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:MENDOZA
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-982-0666
Mailing Address - Street 1:62 CAMERON RD
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3303
Mailing Address - Country:US
Mailing Address - Phone:201-244-6932
Mailing Address - Fax:
Practice Address - Street 1:62 CAMERON RD
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-3303
Practice Address - Country:US
Practice Address - Phone:201-244-6932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01159700261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy